Grading of Extraction and Its Relationship with Post-operative Pain and Trismus, along with Proposed Grading for Trismus

Abstract

IntrOductIOnExtraction of mandibular third molar is a common practice in dentistry. As mandibular third molar is the last tooth to erupt, due to reduced space between mandibular second molar and ramus of mandible, most of the times it is malaligned, impacted, with hooked or curved root. Mandibular third molar's proximity to inferior alveolar canal, position of external oblique ridge as well as impaction status make its extraction more venerable for post-operative complications [1] like pain, swelling and trismus. Not only anatomical factors but bone cutting, sectioning of tooth, flap design [2-4] use of chisel or rotary instrument [5] time taken for surgical procedure [6,7], difficulty of tooth removal and factors associated with operator are also accountable for incidence of complications.Parant, in his paper, classified difficulty of removal of third molar in four grades [8]. Grade I, GradeII, Grade III Grade IV.These grading are much of practical value as they reflect the difficulty of extraction and chances of damaging adjacent vital structure. Grade I extraction, by means of simple forceps, are convenient and with less chances of damaging the adjacent vital structure while grade IV which is complex extraction usually performed in the teeth with unusual positions or with dilacerations or in ankylosed tooth. Extraction of such teeth requires excessive bone cutting with risk of damaging adjacent vital structure. This damage to adjacent vital structure sometimes leads to unwanted post-operative events like post-operative pain, alveolar osteitis, trismus and infections. Postoperative pain and trismus are the two important post-operative complications which affect the day to day activity of the patient. The purpose of this paper is to find out any significant relationship between grading of extraction and Post-operative pain and trismus so that by assuming the grade of extraction we can predict the occurrence of post-operative events. MAterIAls And MethOdsThe study was done in the department of dental sciences, Sri Ram Murti Smarak Medical College Bareilly from December 2009 to November 2013. In this prospective study 180 consecutive patients presented for third molar extraction, fit in inclusion criteria were included. Patient's brief history and examination details were recorded in a specially designed perform for this purpose. Patients with thyroid disorders, pregnant ladies, women on oral contraceptives [9] uncontrolled diabetics, uncontrolled hypertensive, cardiac patients and patients with chronic renal disease were not included in the study because alteration in post op drug regimen can cause bias. Patients included in the study were advised not to smoke (if they were smokers) at least for three days before surgery to one week after surgery as López-Carriches C et al., [10] found that smoking increases chances of trismus. All the patients taken for study were medically fit and with a valid reason for extraction of third molar.Before extraction all patients were asymptomatic or made asymptomatic by the us...

Intraoperative accidents associated with surgical removal of third molars

“…Those authors also observed more accidents and complications relative to the complexity of surgical procedures. Other studies show the post-operative morbidity increase with longer procedures 19 . This study found no relationship between complications and surgical time.…”

Can Teledentistry Replace Conventional Clinical Follow-Up Care for Minor Dental Surgery? A Prospective Randomized Clinical Trial

“…If there is an increased risk of postoperative complications, telemedical follow-up alone should be questioned on the basis of current data. Risk groups include patients with acute and/or chronic infections in the surgical area [ 45 , 46 , 47 ], higher age [ 40 , 47 , 48 , 49 ], incompliance [ 47 ], impacted teeth [ 45 , 46 , 50 , 51 , 52 ], poor oral hygiene [ 45 , 53 ], systemic diseases affecting wound healing (chronic renal or liver diseases, diabetes mellitus, immunosuppression, malnutrition) [ 47 , 54 ], prolonged operation time [ 43 , 48 , 49 , 51 ], history of radiation, chemotherapy or antiresorptive medication [ 47 , 55 ], bleeding disorders (e.g., hemophilia, thrombocytopenia), antiplatelet therapy or anticoagulation [ 55 ], and habits such as smoking and drinking [ 47 , 56 ].…”

Conventional drilling versus ultrasound and laser osteotomy in mandibular third molar surgery: A comparative study

“…A facial swelling assessment was performed using the methodology of Gabka and Matsumura 23 (Figure 1). The degree of mandible postoperative contracture, measured as an interincisal distance by maximal mouth opening, was determined as I degree when 1%−33% limitation in mouth opening was registered; II degree—34%–66%, and III degree—from 66% to 100% 24 . The postoperative pain intensity was registered using a visual analog scale, as follows: 1–4 mm, mild pain; 5–7 mm, moderate pain; 8–10 mm, severe pain 21 …”

“…The degree of mandible postoperative contracture, measured as an interincisal distance by maximal mouth opening, was determined as I degree when 1%−33% limitation in mouth opening was registered; II degree-34%-66%, and III degree-from 66% to 100%. 24 The postoperative pain intensity was registered using a visual analog scale, as follows: 1-4 mm, mild pain; 5-7 mm, moderate pain; 8-10 mm, severe pain. 21 In all mandibular third molar extractions, an equal standard protocol was performed by the same oral surgeon.…”